An experience from Belarus on how allocative efficiency analysis changed HIV budgets

Belarus’ HIV response is faced with the need to provide treatment to a larger number of people living with HIV than ever before and to simultaneously continue scaling up prevention. How to do this in a context of limited resources, poses a major challenge for any planner. Most recent HIV estimates from Belarus illustrate the rapidly growing challenge. UNAIDS estimated that the number of PLHIV in Belarus increased from 5,600 in the year 2000 to 35,000 in 2015. New HIV infections increased from 1,700 per year in 2000 to 2,600 in 2010 and then doubled again to reach 5,300 in 2015.

Sergio Carmona and Tendesayi Kufa-Chakezha are guest blog contributers from South African National Department of Health: National Health Laboratory Services and South African National Department of Health: National Institute of Communicable Diseases, respectively.

South Africa has the largest HIV treatment program in the world with over 3 million people currently on antiretrovirals. Every year, millions of VL and CD4 count tests are carried out to check treatment eligibility for new HIV cases (CD4 count) and treatment success in those on antiretroviral therapy (ART). A VL test monitors viral suppression, the goal of ART given to a HIV-infected person. The CD4 count checks whether the patient suffers from immune deficiency due to low CD4 counts and tracks recovery of the immune system during ART. In 2014, close to half of all VL tests carried out in lower-middle income countries were done in South Africa. In addition, large numbers of CD4 cell counts have been done routinely to predict patients’ risks for opportunistic infections and provide preventive therapy where indicated. While VL and CD4 testing are essential to monitor individual ART patients, the data is also useful in tracking the impact and performance of the ART program as a whole.

The bloody civil wars that wracked Sierra Leone and Liberia in the 1990s did more than kill hundreds of thousands over the course of a decade. They also decimated the health systems of both countries, setting the stage for the rapid spread of Ebola and threatening global health security.

This Op-Ed originally appeared in the China Daily, USA.
A technician carries out a blood test for HIV virus at Jinan AIDS lab in East China's
Shandong province on Nov 30, 2015. [Photo/IC]

While the last half century has seen major advances in global health, new challenges are now threatening these hard-won health gains. One of these is antimicrobial resistance (AMR), or drug-resistant infections which can no longer be treated by antibiotics and other antimicrobial drugs. AMR is on the increase globally both in humans and animals.

Today the world is celebrating “One Health Day.” Sometimes great ideas appear simple, even intuitive: the One Health concept was created to demonstrate that the health of people and animals are interconnected, and that these are in turn, inextricably bound to the health of the environment on which all life depends.

Armed conflict and violence disrupt social support structures and exposes civilian populations to high levels of stress. The 2015 Global Burden of Disease study found a positive association between conflict and depression and anxiety disorders. While most of those exposed to emergencies suffer some form of psychological distress, accumulated evidence shows that 15-20% of crisis-affected populations develop mild-to moderate mental disorders such as depression, anxiety, and post-traumatic stress disorders (PTSD). And, 3-4% develop severe mental disorders, such as psychosis or debilitating depression and anxiety, which affect their ability to function and survive. If not effectively addressed, the long-term mental health and psychosocial well-being of the exposed population may be affected.